Wednesday, 31 March 2010

I'm late with this because it hasn't previously been mentioned anywhere in the English-speaking media, but a brief lament in the British Medical Journal has alerted me to Poland's rejection of a total smoking ban.

The lower house of parliament (Sejm) has voted for a much more liberal amendment to a bill banning smoking in public places in Poland, allowing areas in pubs and clubs where smokers can light up a cigarette.

The vote in the Sejm yesterday evening - carried by 217 for, 165 against and 48 abstentions - came a shock to the parliamentary health committee which had recommended a total smoking ban in public. Under the new amendment, it will be possible in small restaurants and pubs for the owner to decide whether a smoking ban would be in place. In premises over 100 square meters a separate smoking area must be provided. If the premises with an area of over 100 meters has more than one room, the owner decides which of them is a smoking area. Smoking rooms would also available in schools, universities, hospitals, and workplaces.

The rules would not prohibit the sale of e-cigarettes.

Grzegorz Dolniak, the deputy head of the Civic Platform in the Sejm said after the vote that a complete ban would be a “dead law” and probably unenforceable. “It is necessary to preserve common sense and also give a chance to non-smokers who do not want to be exposed to passive smoking.” He also said a complete ban would hurt businesses.

This is yet another example of a European country rejecting the Anglo-Saxon policy of zero tolerance. The Poles have used "common sense" to produce a "liberal amendment". They have respected property rights while accommodating both smokers and nonsmokers. It works in the Netherlands, Spain, Portugal, Austria, Bulgaria, Croatia, the Czech Republic, Belgium, Greece, Germany etc. etc.

Apart from a handful of well-paid and highly vocal zealots, who could find such a system objectionable?

Monday, 29 March 2010

Two important articles have recently appeared on the subject of what we might properly describe as junk science. At the heart of the issue lies epidemiology which, whilst it has its uses, finds false positives more often than not. The problem is two-fold: there are too many epidemiologists chasing too few real associations and it is too easy to use statistics to 'prove' whatever you (or your funders) want to prove.

I would argue that the rot set it with the passive smoking studies (particularly after 1990). Certainly, the heart attack miracles represented the moment when epidemiology jumped the shark, but the corruption and folly was evident before that and has infected countless areas of research since. Epidemiology has been hopelessly debased and it is dragging the reputation of real science down with it.

Passive smoking is just one small part of this, but it is an important case study because it demonstrated that junk science would be tolerated if it was in the name of a 'good cause'. But by accepting nonsignificant statistical associations of 1.10-1.30 (ie. a 10-30% increase in risk), it opened a Pandora's box which could not easily be closed.

In Velvet Glove, Iron Fist, I quote John Brignell, whose book The Epidemiologists I warmly recommend. What he says about the EPA's 1992 secondhand smoke report has come to pass:

There is no doubt about it - every study of passive smoking, if evaluated on the basis of statistical probity, shows that it is harmless; but probity had been jettisoned. It was a deeply symbolic and decisive moment in time. Once you could get the world to accept a relative risk of 1.19 at a significance level of 10%, you could prove that anything caused anything.

The scientific era that had started with Bacon four centuries earlier had come to an end and the world was ready to return to the rule of mumbo-jumbo.

The problem is exacerbated by the bastardisation of the peer-review process. All too often, peer-review is a rubber stamp from like-minded people who sometimes seem not to have even read the studies they are approving. How else can we explain basic mathematical errors appearing in studies by Konrad Jamrozik and Stanton Glantz?

Dr Richard Smith, the former editor of the British Medical Journal, discussed the peer-review process on his BMJ blog last week in the wake of more junk science being exposed and came up with a radical solution.

Prepublication peer review is faith based not evidence based, and Sudlow’s story shows how it failed badly at Science. Her anecdote joins a mountain of evidence of the failures of peer review: it is slow, expensive, largely a lottery, poor at detecting errors and fraud, anti-innovatory, biased, and prone to abuse.

So rather than bolster traditional peer review at “top journals,” we should abandon prepublication review and paying excessive attention to “top journals.” Instead, let people publish and let the world decide. This is ultimately what happens anyway in that what is published is digested with some of it absorbed into “what we know” and much of it never being cited and simply disappearing.

My answer to this objection is that this happens now. Much of what is published in journals is scientifically poor—as the Science article shows. Then, many studies are presented at scientific meetings without peer review, and scientists and their employers are increasingly likely to report their results through the mass media.

Smith's solution is controversial. I tend to prefer James Le Fanu's idea of closing down every department of epidemiology. Making a training course on epidemiology and statistics compulsory for journalists who report on science wouldn't be a bad idea either.

Smith's idea of scrapping peer-review might back-fire. It could lead to more false positives being reported but, as he says, how much worse can things really get? It would at least stop defenders of junk science hiding under the halo of the peer-review. Science would have to stand on its merits rather than relying on the appeal to authority.

The other important article appeared in Science News, discussing why most epidemiological findings are false.

It’s science’s dirtiest secret: The “scientific method” of testing hypotheses by statistical analysis stands on a flimsy foundation. Statistical tests are supposed to guide scientists in judging whether an experimental result reflects some real effect or is merely a random fluke, but the standard methods mix mutually inconsistent philosophies and offer no meaningful basis for making such decisions. Even when performed correctly, statistical tests are widely misunderstood and frequently misinterpreted. As a result, countless conclusions in the scientific literature are erroneous, and tests of medical dangers or treatments are often contradictory and confusing.

As I have argued before, the 95% confidence interval beloved of epidemiologists is nothing of the sort. It depends on all things being equal which they never are when human beings are involved.

Replicating a result helps establish its validity more securely, but the common tactic of combining numerous studies into one analysis, while sound in principle, is seldom conducted properly in practice.

He's talking about meta-analysis, in which a bunch of shoddy, nonsignificant statistical associations are combined to manufacture a single significant finding. That is what the EPA in the secondhand smoke report that Brignell mentions above.

“There is increasing concern,” declared epidemiologist John Ioannidis in a highly cited 2005 paper in PLoS Medicine, “that in modern research, false findings may be the majority or even the vast majority of published research claims.”

I am pleasantly surprised to hear that Ioannidis's study is "highly cited". It is, in my opinion, one of the most important articles ever written about epidemiology. I quoted it at length in the collection of extended footnotes I recently published as an addendum to Velvet Glove, Iron Fist. If you only read one article about the science of statistics, read that.

As Ioannidis writes:

A meta-analytic finding from inconclusive studies where pooling is used to “correct” the low power of single studies, is probably false if R ≤ 1:3.

That's your EPA and SCOTH meta-analyses right there (1.19 and 1.24 respectively for passive smoking/lung cancer).

Ioannidis has much to say about the effect of bias. He makes the obvious, but rarely spoken, point that bias does not need to be financial, but can just as readily be ideological.

Prejudice may not necessarily have financial roots. Scientists in a given field may be prejudiced purely because of their belief in a scientific theory or commitment to their own findings.

It is surely difficult to argue that anti-smoking campaigners turned epidemiologists do not have an inherent bias, quite apart from the financial rewards associated with coming up with the 'right' result. Indeed, all the factors Ioannidis identifies as being likely to lead to false positives apply to secondhand smoke studies.

Corollary 1: The smaller the studies conducted in a scientific field, the less likely the research findings are to be true.

Corollary 2: The smaller the effect sizes in a scientific field, the less likely the research findings are to be true.

Corollary 3: The greater the number and the lesser the selection of tested relationships in a scientific field, the less likely the research findings are to be true.

Corollary 4: The greater the flexibility in designs, definitions, outcomes, and analytical modes in a scientific field, the less likely the research findings are to be true.

Corollary 5: The greater the financial and other interests and prejudices in a scientific field, the less likely the research findings are to be true.

Corollary 6: The hotter a scientific field (with more scientific teams involved), the less likely the research findings are to be true.

And, remember, even with all these biases, most passive smoking studies have not found a statistically significant association with lung cancer.

Much of what S. Stanley Young says in this podcast for American Scientist also applies, although most of his examples are related to diet—another area where junk statistics are endemic. He concludes that 90% of epidemiological findings are false. If he's right it would turn the 95% confidence interval on its head. I don't think he's far off.

"We were going to the hospital and we told the doctor. She said it was the particles on her clothing that was the real effect for her asthma."

This is the thirdhand smoke myth, is it not? If this anecdote is true, and it's not just some ASH stooge telling tale tales, this doctor should be struck off. There is no place in medicine for the near-medieval superstitions that this quack is peddling. Get rid of her.

"That was when we realised it wasn't helping even smoking outside."

"We thought we were doing the right thing by going outside and smoking. We didn't want to smoke in the house with the kids because of the passive smoking.

"We thought going outside was eliminating it, but it wasn't."

Dear me. A lie really can get around while the truth is still putting its shoes on.

A few weeks ago someone found this blog under the key phrase 'can third hand smoke cause a 1 year old to wheeze?' That stuck in my mind because I pictured a mother whose baby was unwell neglecting the real reason for its illness in favour of some garbage she had read in a newspaper.

That, to me, is the human cost of all this trash. Lies have been everywhere today and those who have told them will go home believing that it's all in a good cause. They have said, for example, that passive smoking causes 40 cot deaths a year.

Now, I can sit here and explain that this is an estimate built on a projection built on a flawed study. I can tell you that the supposed relative risk is almost certainly due to a failure to control for socio-economic status. I could add that cot deaths are rare in countries like Russia which have high smoking rates and that there is no correlation between rates of smoking and rates of cot death. But ultimately what matters is that some parents who have been bereaved through cot death, and happened to smoke, will feel that they are to blame for their child's death. And that, I think, is unforgivable.

I was interviewed on BBC Scotland radio this morning on the subject of banning smoking in cars (listen here for 7 days, 2.17 hours in). Sleepy though I was—and coming off the back of a hilariously one-sided vox pop—I tried to make the point that the simple act of opening a window in a moving vehicle provides ample ventilation to disperse secondhand smoke.

Prof John Britton had earlier told the BBC that levels of secondhand smoke in cars are twenty times higher than in smoky bars. As a medical man, his opinion naturally trumped mine as far as the presenter was concerned. Nevertheless, it's worth finding out this '20 times higher' claim comes from.

A good place to start is a heavily referenced report from ASH (UK). It claims that:

According to a report by the Ontario Medical Association, secondhand smoke levels in cars can be 23 times greater than in a house.

ASH give a citation of this report from the Ontario Medical Association, which says:

Based on the evidence that exposure to SHS in a vehicle is 23-times more toxic than in a house due to the smaller enclosed space, the state of Colorado drafted a bill that would impose fines on adults caught smoking in cars when a child is present.

But what evidence is this? Their only reference turns out to be a news story from the Rocky Mountain News, not exactly a reliable scientific source.

ASH do, however, have another source:

A study comparing secondhand smoke particle concentrations in a vehicle with those in a bar which allowed smoking, found in-vehicle concentrations 20-times greater than inside the bar.

Again there is a citation, this time to an actual scientific journal, but the article in question does not measure secondhand smoke in cars, nor does it attempt to. It certainly doesn't give any estimate of how much more secondhand smoke is in cars than other locations, and it doesn't cite any references that might lead us to find an article that does.

And there the trail ends. Such is the game of Chinese whispers that passes for evidence-based medicine these days.

If you want to find some real science on this issue, you have to turn to an American Journal of Preventive Medicinestudy from 2006, which measured particulate matter (PM2.5) in vehicles.

Bearing in mind that the EPA's 'hazardous' level for 24 hour exposure is 250 ng/m3, this study found average peak concentrations of 271 ng/m3. But they did so by keeping the windows closed. When a window was opened, the level was only 51 ng/m3. This is a fraction of what would be found in a smoky bar (200-500 ng/m3) and is well within the EPA's limit (which, remember, is for 24 hour exposures, not the occasional car journey). And after smoking, levels quickly fell to the same found in a nonsmokers' car.

The study also measured carbon monoxide levels, with even less impressive results. When the window was opened, levels barely changed at all.

Another study sometimes cited carried out a similar experiment but only opened the window by 3 inches. Even with this restricted ventilation, average levels of PM2.5 were 119 ng/m3—well below the EPA's hazardous level.

All of which suggests that—if smoking in cars is a problem at all—it is one that can be simply solved by opening the window. And that, of course, is what everyone already does.

Would I agree with a law forcing people to open the window whilst smoking? I probably would, if I thought that would be the end of the matter, but we all know that it won't be because protecting people from secondhand smoke is not the purpose of the Royal College of Physicians' latest 'demands'. By calling for a total ban on smoking in cars, even when no one else is present, they have finally given the game away. This issue isn't about science and it's not about 'protecting' nonsmokers. It never has been.

UPDATE

While I was on BBC Scotland, Tony Blows was on Radio 5, making his point rather more forcefully. He called Deborah Arnott a liar which, considering she brought up the Scottish heart scam, I suppose is fair comment. F2C have the audio.

Incidentally, I was told that the producers wanted me to debate with a spokesman from an anti-smoking group but the spokesman refused! I bet Arnott now wishes she'd ducked out as well.

Further evidence that smoking bans do not reduce heart attacks has recently appeared in the Journal of American Physicians and Surgeons. A new paper by Dr Michael Marlow points out the numerous methodological problems with the 'heart attack miracle' studies that have appeared in recent years. He also warns that using junk science to make claims that do not meet the "simplest tests of believability" may have adverse consequences.

Marlow concludes:

Publicly led research on public health effects of smoking bans has overstated benefits by overreaching on conclusions, excluding studies that contradict predetermined conclusions, and relying on studies subject to biases outlined above. This pattern is lamentable for a number of reasons. One is that efforts claiming to improve public health appear to be driven more by social agendas than by science.

Regular readers will already be aware that the largest study ever conducted found no significant reduction in heart attacks following smoking bans. And we know that heart attack miracles in England, Scotland and Wales have been disproved by routine hospital data. As I have said before, a cut in heart attacks of 10%, 20% or 30% as a result of a smoking ban is not just implausible, it is literally impossible. Even if everyone gave up smoking as a result of a ban, the heart attack rate would not drop so sharply.

It will, however, take more than mere facts to obstruct a fairy-tale that holds appeal for so many. Indeed, a new shaggy-dog story is being constructed in England as we speak.

When active enforcement begins, many jurisdictions recommend the use of high-profile prosecutions to enhance deterrence. By identifying prominent violators who have actively defied the law or who are well known in the community, by taking firm and swift action and by seeking maximum public awareness of these activities, authorities are able to demonstrate their resolve and the seriousness of the law.

An anti-smoking charity called today for Gorillaz frontman Damon Albarn to be prosecuted for smoking a cigarette on stage on the first night of a tour.

Bass guitarist Paul Simonon, formerly of The Clash, also smoked during the show in front of an "intimate" audience of about 500 fans.

Now the anti-smoking charity Action on Smoking and Health (Ash) has called for Albarn and Simonon to be prosecuted to make an example of them.

Spokeswoman Amanda Sandford said: "There can be no excuse for that as it is an indoor place and the law is very clear."

"No-one is allowed to smoke on stage unless it's relevant to the act. They should be fined. It's not just the artist, it's the premises where the act is held. I would expect the local authority to take the appropriate action. It's not just illegal but more importantly it's about the message it sends out to fans."

"People in the public eye have a duty not to promote smoking. It's very irresponsible - I suppose they think it's rebellious and they may get some extra kudos from it and maybe some extra publicity."

Hmm. Who do you think is trying to get "extra publicity" here? Unpopular, state-funded pressure group ASH or world famous musician Damon Albarn?

Despite the higher annual costs of the obese and smoking cohorts, the healthy-living cohort incurs highest lifetime costs, due to its higher life expectancy, as shown in Table 1. Furthermore, the greatest differences in health-care costs are not caused by smoking- and obesity-related diseases, but by the other, unrelated, diseases that occur as life-years are gained (Table 1). Therefore, successful prevention of obesity and smoking would result in lower health-care costs in the short run (assuming no costs of prevention), but in the long run they would result in higher costs.

A more complete accounting of the health costs of smoking not only increases the size of the costs, but also reallocates costs and implies net financial benefits for some parties. Governments save on the costs of old-age medical care, social security, and nursing home care due to the earlier death of smokers. (This result does not mean that it is desirable that people die early; it means that in determining financial cost, if that is the justification for a payment, a correct measure of the loss will only be calculated if these effects are included.) Smoking has apparently brought financial gain to both the federal and state governments, especially when tobacco taxes are taken into account. In general, smokers do not appear to currently impose net financial costs on the rest of society.

Net additional external costs borne by non-smokers worked out to $244 million for Canada in 1986. However, smokers are responsible for a much larger flow in the other direction. In the pension area alone, nonsmokers benefit from a transfer of $1.4 billion mainly because smokers tend to die before non-smokers do if we use risk coefficients established by the medical profession. Finally, the massive tax burden borne by smokers alone means that they account for a further transfer of close to $3.2 billion to the benefit of non-smokers.

The widespread belief that smokers do not pay their own way is the result of repeated assertions that are totally lacking in empirical support. There is simply no evidence that smokers impose costs on others by making more use of medical care than do nonsmokers.

On balance, most studies find that smokers cost the government less in terms of health care outlays than the sum of what they save the government in unclaimed retirement benefits and pay the government in tobacco taxes at existing tax rates.

Although nonsmokers subsidize smokers' medical care and group life insurance, smokers subsidize nonsmokers' pensions and nursing home payments. On balance, smokers probably pay their way at the current level of excise taxes on cigarettes; but one may, nonetheless, wish to raise those taxes to reduce the number of adolescent smokers. In contrast, drinkers do not pay their way: current excise taxes on alcohol cover only about half the costs imposed on others.

The results imply that lifetime expenditure is higher for nonsmokers than for smokers because smokers' higher annual utilization rates are overcompensated for by nonsmokers' higher life expectancy. Population simulation, taking into account the effects of past smoking on present population size and composition, suggests that 1976 expenditure would have been the same if no male born since 1876 had ever smoked. The male population would have been larger, particularly at older ages, increasing medical care expenditure, but this increase would have been offset by lower annual medical care utilization rates. Thus the results imply that smoking does not increase medical care expenditure and, therefore, reducing smoking is unlikely to decrease it.

Bear in mind that since many of these studies were conducted, tobacco taxes have risen substantially and, therefore, the government's net profit from smokers has increased further.

The Policy Exchange also reckons that smokers are absent from work more often than nonsmokers, but that's not what this study found...

There was no difference in sickness absence between smokers and non smokers, however there was an increase in sickness absence with increasing Body Mass Index (BMI) (correlation coefficient 10.9 %-p=0.005) and perhaps surprisingly there was an increase in sickness absence with increasing exercise participation (correlation coefficient 7.7% p=0.045).

Results: Health care costs for smokers at a given age are as much as 40 percent higher than those for nonsmokers, but in a population in which no one smoked the costs would be 7 percent higher among men and 4 percent higher among women than the costs in the current mixed population of smokers and nonsmokers.

Conclusions: If people stopped smoking, there would be a savings in health care costs, but only in the short term. Eventually, smoking cessation would lead to increased health care costs.

The study found that although annual health-care costs are highest for obese people earlier in life (until age 56 years), and are highest for smokers at older ages, the ultimate lifetime costs are highest for the healthy (nonsmoking, nonobese) people.

Friday, 19 March 2010

Smoking is, depending on your point of view, either an issue of health or an issue of liberty. It's not really an issue of economics. The two warring factions believe health/liberty to be priceless so economics go out of the window.

It has long been recognised that tobacco brings in far more in tax revenue than is spent on treating 'smoking-related' diseases. What is less well recognised—because few people are so indelicate as to say it—is that the government has a financial interest in seeing people die at the age of 65, or as soon as possible thereafter. It's not a nice thought, but it's simple economics. Between the ages of 16 to 65, most of us are net contributors to the state. Before and after that, we are an expense.

From a strictly economic perspective, the government's ideal citizen is someone who works all their life, pays a lot of tax and then dies not too long after retiring. Smokers, for instance.

This is an uncomfortable fact for tobacco control. Nonsmokers must be taught to believe that smokers hurt them both physically and financially. They don't, but they've done a good job of convincing them on the first count, and now it is time for the second.

Enter the Policy Exchange. This think-tank has released a report which makes the astounding claim that British smokers cost the state more than the £10 billion they pay in tobacco tax each year. They do so using the most appalling methodology.

The fundamental problem—and this is a feature of all such studies—is that they assume that if a smoker doesn't die from a 'smoking-related' disease, he won't die from anything. Or at least not anything that costs money to treat. This is, shall we say, rather counterintuitive.

It also assumes that the money to treat these diseases shouldn't come from the 11p in the £1 National Insurance contribution that every Briton is compelled to pay, but from additional tax on tobacco. In effect, the smoker's National Insurance contributions are given to a nonsmoker. Again, this seems a tad unfair and is hardly in the spirit of the NHS.

Once you've swallowed all that, you are asked to believe that smoking costs the NHS £2.7 billion. This figure is often bandied around and the usual source is a 2008 ASH document called 'Beyond Smoking Kills'. This, in turn, cites another ASH document: 'The Cost of Smoking to the NHS' by C. Callum. But this document does not seem to exist. There is no trace of it on the ASH website and, for we know, the £2.7 billion was plucked out of thin air. All that is left is this vague leaflet, also from ASH.

But it'll do for the Policy Exchange, who slap another £200 million on and...

Ker-ching: £2.9 billion in healthcare costs.

So far, so good. But a lot more is going to be required if we are to get beyond that pesky £10 billion mark.

To that end, £4.8 billion is conjured up for 'lost output'. This is the contribution smokers would have made to society had they not died during their working life. Matthew Sinclair spots the problem with this at ConservativeHome:

That loss is clearly mostly to the smoker themselves (the income they miss out on), that means it isn't a societal cost but a private one and can't justify Pigovian taxation.

Quite so. Let's not forget that the government does not own its citizens' bodies or their lives. We do not have a duty to work for the state or to maximise our productivity. You would hope that a supposedly centre-right think tank might recognise that.

The Policy Exchange assumed that these smokers wouldn't have any other health problems (rather unlikely), and that they would have worked to the age of 74 (what?!!). This second assumption is crucial because only a fairly small proportion of smokers die before the age of 65.

They did, however, find 757 smoking-related deaths amongst the 35-39 age group (really? Who are they?) who each 'cost' society £750,000 (!) by dying young.

Better still, they assumed that none of these smokers would have had a life on the dole or on incapacity benefit. As a result, they didn't have to face the awkward task of showing a smoker saving the state money by dying.

Nor do they mention any of the pensions, benefits, prescriptions, hip replacements, meals on wheels, geriatric care and operations that won't have to come out of the pot thanks to smokers dying prematurely. And that's a damn good job, because that amount alone would dwarf all the rest of the figures combined and lead the reader to the unpalatable, but truthful, conclusion that smokers are net contributors to the economy.

Oh, and stick another £713 million for deaths from passive smoking, even though they only exist on an epidemiologist's lap-top.

Ker-ching! £4.8 billion

Then there's litter collection. Everyone in Britain pays to have the streets cleaned but, according to the Policy Exchange, smokers should pay twice. The cost of collecting cigarette butts is, they reckon, £342 million. Stick it on the price of fags.

Ker-ching! £0.3 billion

And what about those cigarette breaks? They must be costing the country a fortune, right? The Policy Exchange estimates that smokers spend 5 to 10 minutes smoking while at work. Just imagine all the wealth they could be creating in that time! It's not as if everyone takes a break at work, especially since two 15 minute work breaks are mandatory under European law. Nah, let's pretend it's unique to smokers and call it 'lost productivity'.

How on earth is a smoking break a 'cost to the taxpayer'? That's like saying that since most people don't work at weekends, weekends cost the economy about £400 billion per annum

Never mind. Call it a cost and let's get to that £10 billion. And let's slap another £2.5 billion on because smokers are supposedly absent from work for 33 hours more than nonsmokers each year. This 33 hour absenteeism might have nothing to do with smoking, and probably isn't. It might not even be true at all, but it's grist to the mill. Okay, someone else estimated that the cost was less than half of that, but let's go with the highest figure we can find. Hence...

Ker-ching! £5.4 billion

The only problem is the tobacco industry's undoubted contribution to the economy. British American Tobacco alone turned over £33.9 billion in 2008 and is a significant employer. Without smoking, these people won't have a job, won't pay tax and will be claiming benefits. The same is true of their suppliers, distributors and retailers. This is a tangible economic benefit and the Policy Exchange does not want benefits eating away at their figure. So how to skirt around it?

Smoking impacts on business in a variety of ways, and, when viewing our current paradigm, losses should be considered alongside benefits.

Agreed. Off you go then.

Previous studies have demonstrated that, were people not to spend money on cigarettes, they would direct their expenditure elsewhere. Other leisure industries support greater workforce, and have a significantly lower tax profile. This leads to an aggregate increase in employment, with consequent economic benefits. Indeed, they estimate that the benefits of to be derived from leisure spending going elsewhere would significantly outweigh the detrimental effects.

In other words, ex-smokers will spend their money elsewhere, thereby helping other industries which will then create new vacancies for those redundant tobacco execs and newsagents to fill. Well, yes, probably. But there is no guarantee that those industries will be in the UK.

More to the point, the fact that people might find work elsewhere (though doubtful with over 8 million unemployed) is not a reason to ignore the costs of unemployment. I don't seem to recall many people in the 1980s telling the miners that their plight didn't matter because new industries would emerge. Nor have I noticed UNISON telling their members not to worry about mass redundancies because the money saved will be spent elsewhere.

A cost is a cost. Any financial spreadsheet needs to show that.

For these reasons we exclude the role of business from our calculation.

How very convenient. We wouldn't want the "role of business" to intrude on an economic analysis, would we?

And that, my friends, is how the Policy Exchange does its sums. They get to a figure of over £13 billion and want a 5% increase in the price of cigarettes which, by a remarkable coincidence, is exactly what ASH were demanding two weeks ago.

Its lead author, Henry Featherstone, seems to be rather chummy with ASH, as DickPuddlecote has noted. He is already utilising the fallacious arguments of that 'charity', turning up with a false dichotomy at ConservativeHome where he accuses his many critics of "defending smoking"—ie. anyone who criticises the 'good guys' must be helping the 'bad guys'.

It's not defending smoking, Henry, it's defending reason.

Funnily enough, I was at the Policy Exchange last night. They were talking bollocks then as well.

UPDATE:

Mark Littlewood (Institute of Economic Affairs) attacks the notion that it is our duty to maximise our productivity for the state here.

Thursday, 18 March 2010

Further to yesterday's post about the latest dodgy heart attack/smoking ban study, Dr Michael Siegel shows—yet again—how a global news story has been manufactured out of nothing.

Here we have a study where the paper itself asserts that no causal conclusion can be drawn, yet the media were apparently told that the study showed a reduction in severe heart attacks due to the smoking ban.

Why bother doing the research if you are going to tell the media the same thing no matter how the study results come out?

In addition, the study itself uses misleading, inappropriate, and non-scientific language in describing its findings.

Why can't researchers writing about this issue of smoking bans and heart attacks simply tell it like it is? Why do they have to use non-scientific weasel language to avoid what is apparently a pre-determined conclusion? And how does this get past the peer review of the journal?

Whatever these researchers are getting paid to prostitute their integrity (if they ever had any), I hope they think it's worth it.

Snuscentral.org have recently reviewed Velvet Glove, Iron Fist: A History of Anti-Smoking:

Written by Christopher Snowdon, the book is somewhat different than I expected. It is not a defense of smoking. It is much more a connecting of the dots from the earliest failed attempts to eradicate smoking shortly after a couple of sailors on Columbus’s journeys brought tobacco to Spain, to the modern incarnation of today’s rabid anti tobacco activists.

I recommend anyone interested in this topic to buy a copy. Mine is already dog-eared and well used looking. It’s a great reference tool/resource to have handy when debating anti-tobacco forces.

Wednesday, 17 March 2010

A possible link between a smoking ban in bars and restaurants and a reduction in severe heart attacks has been found by scientists.

Edinburgh University researchers made the findings during a study in New Zealand three years after a smoking ban was introduced there.

Really? Because that's not what was reported (albeit, buried deep) in a study Michael Siegel mentioned last year:

In the year following the smoking ban, the rate of hospitalization for acute myocardial infarctions (heart attacks) increased in New Zealand. There was no significant difference in the pre- and post-ban trends.

Unstable angina admissions decreased in the year after the smoking ban, but there was no significant difference in the pre- and post-ban trends in the Poisson regression analysis.

When combining heart attacks and unstable angina to look at trends in the rate for all acute coronary events (also known as acute coronary syndrome), there was no significant change in acute coronary events from before to after the smoking ban, and no significant difference in the pre- and post-ban trends in the Poisson regression analysis.

The paper concludes: "There was therefore no clear evidence that the hospitalisation rate for these health outcomes reduced in the first 12 months after implementation of the SEAA [Smoke-free Environments Amendment Act]."

This was confirmed in a report by the New Zealand government* which said:

In conclusion, the health impact study did not detect a significant effect of the SEAA [smoking ban] (2003) on the rate of hospitalisations for adult cardiovascular and respiratory diseases.

But now, all of a sudden, someone with a PhD in Geography on the other side of the world has discovered a New Zealand heart attack miracle?

Overall, the research showed heart attacks among people aged 30 and over fell by an average of 5% in the three years following the ban.

5% over three years is exactly what you would expect to see given the long-term trends. Indeed, one would expect to see a rather sharper drop than that. How dumb do they think we are?

*(The original version of this report has been deleted but can still be read here. The new study, of course, has yet to be published)

Give 18 certificate to any film with a smoking scene, demand campaigners

FILMS that feature smoking should be given an automatic 18 rating to protect teenagers against taking up the habit, according to a new study.

The first line tells you everything you need to know about this garbage. Real scientific studies do not include policy demands. As The Scotsman recognises in its headline, these people are campaigners, with one particular name standing out...

The study, compiled by Dr Christopher Millett of Imperial College London and Professor Stanton Glantz of California University, advocated an overhaul of the ratings system.

By my reckoning, this is Stanton Glantz's 20th 'study' on the effect of smoking in the movies.

The researchers assessed the number of onscreen smoking or tobacco occurrences in 572 top grossing films in the UK between 2001 and 2006, including 546 screened in the United States, plus 26 high-earning films released only in the UK.

Have these people really got nothing better to do? Couldn't we send them out into the community, washing cars or something?

As it happens, I received the new study and the worldwide press release (embargoed until 16th March) last week. I was expecting to see blanket news coverage. In fact only The Scotsman and the Yorkshire Post covered it at all. Perhaps the media are becoming weary of Glantz's incessant junk science. The comments at The Scotsman certainly suggest that the fanatics have got a lot of work to do if they are going to persuade the public.

As for the BBFC, their position is clear:

Sue Clark, spokeswoman for the BBFC, said imposing an 18 rating on films which feature scenes of smoking is "not going to happen".

She said: "Sometimes smoking is included in a film for reasons of historical accuracy. The only time we would consider stepping in is if we felt a film was actively promoting smoking. But I have never seen a film that did that."

So I get back from The International Conference Against Prohibition, pick up a copy of The Metro at Gatwick Airport and what do I spy?

Thousands banned from using perfumes at work

Thousands of civil servants could kick up a stink after being warned by bosses not to wear strong perfumes or aftershaves—to avoid costly legal action.

The Metro has jumped the gun a little here. For its online edition the headline has been changed to the more subdued, but more accurate:

Please don't wear perfume, Detroit tells workers

City employees in Detroit are being urged not to wear perfume or deodorant—after a lawsuit from an employee who couldn't stand her colleague's perfume.

This is the case of Susan McBride, who has successfully sued her employer on the basis that she has Multiple Chemical Sensitivity (MCS) and that...

... her colleague not only wore a strong scent but also plugged in a room deodoriser which forced her to go home sick.

The trouble is that Multiple Chemical Sensitivity doesn't exist. No serious physician or scientist believes otherwise. MCS is a rather unusual 'disease' since it only seems to affect middle-aged, middle class women, mainly in North America. These are the same kind of people who believe they are "allergic" to tobacco smoke (a biological impossibility).

As I discussed in Velvet Glove, Iron Fist, it started in Halifax, Nova Scotia. I quoted Dr Ronald House of St Michael's Hospital (Toronto):

"The uproar is fascinating from a cultural view. But it isn't good medicine, it's folly—political pandering to a few rather strident activists." (p. 343)

Sound familiar?

And yet this woman won her lawsuit, largely because the City of Detroit was foolish enough to cave in to the "rather strident activists" in 2005, when Erin Weber won a similar lawsuit (also in Velvet Glove). And The Metro may well be right when it says that employers will bring in workplace bans on perfume for fear of litigation. This is precisely what happened with secondhand smoke long before the EPA produced its infamous junk meta-analysis, and where America leads, the UK follows.

And speaking of strident activists, The Metro published this letter yesterday:

Smoke out abusers

I simply can't let Steve Lustig's diatribe against Duncan Bannatyne for saying children were being abused by smokers (Metro, Fri), go unchallenged. He thinks it is 'an insult to the victims of genuine abuse' to lump them with victims of smoking parents.

How very quaint. I am 58 years old, yet I am still traumatised by the memory of my father lighting up in the car throughout my childhood, despite pleas from my two younger sisters and I to refrain. His lighting up war invariably followed by all three of us throwing up. The callous disregard from the long-term damage caused by secondary smoking) he inflicted in the pursuit of his selfish pleasure simply beggars belief. And yes, I call that abuse.

By all means smoke yourself into an early grave if that's what lights your fag end. But do it without imposing it on others. Duncan is a true hero.

Costas Andrew Cleater

This guy's father lit up in a car "throughout [his] childhood" and this was "invariably followed by all three of us throwing up"? That's a lot of throwing up, and a very heartless father. You have to wonder how much this story has been embellished over the years, or whether it's true at all. Presumably this fellow would have been happier if he had had the power to turn his father over to the police, as Bannatyne is demanding.

(There's an interesting Channel 4 documentary about Multiple Chemical Sensitivity—including a woman who thinks she's allergic to her own hair—here: Allergic to the 21st Sensitivity.)

Tuesday, 9 March 2010

Quite a bit got cut out of the book before it was published, generally because it didn't fit the narrative. Some of it you may find interesting, some of it you won't. It is, after all, a selection of left-overs, but I thought it was worth putting it out there for the sake of completeness. If you haven't read Velvet Glove, most of it won't even make sense. It's no substitute for reading the book but at least it's free.

Monday, 8 March 2010

I'm currently reading The Logic of Life by Tim Harford. He mentions something about the advertising of nicotine replacement therapy (NRT) which I found interesting (p. 59).

Economists have also found that advertising for nicotine patches and gum seems to encourage non-smoking teenagers to smoke. That's easy to explain if teenagers are rational: the advertisements tell them that there are new ways to help them quit, so rationally it is less risky to start the habit.

It does make sense. If people are told there is an easy way to quit, they will be less tentative about starting. The study he refers to is this:

The results indicate that NRT advertising has no effect on participation but increases smoking by youth who do smoke. The elasticity of smoking with respect to NRT advertising is about .10 and the elasticity of smoking with respect to price is about -1.03. Since average youth smoking is about 5.77 cigarettes per day, an increase of 10 percent in NRT advertising would increase this average to about 5.82 cigarettes per day. It is also estimated that a ban on NRT advertising would be equivalent to a 10 percent increase in cigarette prices.

You will notice that this study doesn't quite confirm what Harford is saying. NRT advertising makes smokers smoke more but "has no effect on participation" ie. it doesn't get non-smokers to start.

This proposition was tentatively confirmed in an earlier study, which concluded:

...those exposed to NRT ads reported stronger perceptions about the ease of quitting, but non-susceptible non-smokers primarily drove this difference. This study suggests that exposure to NRT and Zyban® advertising in an experimental context does not reliably influence youth smoking-related beliefs, especially those vulnerable to becoming regular smokers.

But if NRT ads make people thing it is easy to quit, why wouldn't this perception affect those who are "vulnerable to becoming regular smokers"? You would expect them to be the most affected. How do we even work out who is "vulnerable" and who is "non-susceptible" any way?

The picture is clouded further by the fact that Melanie Wakefield was involved with both of these studies. Wakefield is Deputy Editor of the journal Tobacco Control, which has always been well-disposed to pharmaceutical nicotine. Indeed, one of her other studies on NRT was sponsored by GlaxoSmithKline.

The question of whether NRT advertising increases the smoking rate is, therefore, intriguing but unresolved. I dare say it will remain unresolved for as long as the pharmaceutical industry funds anti-smoking groups, conferences and research. At a time when ASH are calling for a 5% increase in cigarette taxes, it is interesting that research indicates that a ban on NRT ads would have the same effect as a 10% increase in cigarette taxes. But don't expect to hear pharmaceutically funded pressure groups like ASH calling for that any time soon.

Canadians need to do more to reduce their growing waistlines, but the country may not be ready for tough measures and legislation to help shrink the nation, according to the chief public health officer.

First comes the scare-mongering...

"The concern with the increasing rates of obesity is that this may in fact, be the first generation of children to not live as long and healthy as their parents," said Butler-Jones in an interview.

Governments over the years, have passed various pieces of legislation designed to reduce smoking, including increased taxation and packaging requirements, and some health experts have been pushing for similar initiatives to combat obesity.

Proposals include banning the advertising of unhealthy foods, increasing taxes on food that isn't nutritious, subsidizing fruits and vegetables to make them more affordable for Canadians and forcing the food industry to change its labelling, packaging and ingredients.

Does anyone seriously dispute that the slippery slope is real, or that this was not always the next 'logical step'?

Friday, 5 March 2010

ASH Wales' financial accounts have finally come online. I have written previously about how the charity failed to send the Charity Commission the breakdown of where it's money was coming from.

As expected, it transpires that—after the Welsh government—Pfizer is its biggest sponsor. Pfizer does, of course, sell the stop-smoking drugs Nicorette and Chantix/Champix. In addition, ASH Wales' Tobacco Control Conference will be sponsored by Pfizer, McNeil, Novartis and GlaxoSmithKline, all of whom manufacture or market nicotine drugs.

ASH Wales 2008/09 accounts run as follows:

Welsh Assembly Government: £115,800

Pfizer Foundation: £45,168

British Heart Foundation: £24,666

Donations: £2,697

Other: £351

Total: £188,682

Take note of the amount of voluntary donations: just £2,697. Less than 2% of this charity's income comes from the public. Meanwhile, Old Holborn has just announced that the blog-reading public has raised over £9,000 to free the Nick Hogan. Hogan should be released within hours, an extraordinary achievement all done in under a week with virtually no mainstream publicity. Perhaps the MSM will pick up on this story now?

Smokers who go outside for a cigarette are acting as "extra pairs of eyes" and deterring criminals, says Bob Vaughan-Newton.

Since the ban came into force in July 2007, there has been an 80% drop in auto crime in the borough.

Has there, by jingo? Let's see your figures then, sunshine.

Latest figures for Gedling North, which includes Arnold, Daybrook, Woodborough and Ravenshead, show it has dropped by nearly a quarter in the last year, with 287 recorded crimes between April 2009 and this January compared to 378 in the same period the previous year.

But the smoking ban was introduced in July 2007. How about showing us how the crime changed in July-June 07/08 compared to the same period in 06/07?

No? Nothing? Let's move on then.

Mr Vaughan-Newton, crime reduction manager for Gedling Borough Council, said: "We used to have big problems in Gedling North, and Gedling South as well, with people breaking into cars in public car parks down Mansfield Road and the rural pubs in Lambley and Stoke Bardolph. It was all along the A60 corridor.

"Suddenly, with the smoking ban, there were all these extra pairs of eyes on the car park.

"We've actually reduced car crime in the whole of Gedling Borough since the smoking ban in July 2007 by about 80%.

The very defintion of post hoc ergo proptor hoc. I'm not familiar with this part of the country, but I wonder if there could - just possibly - be any alternative explanations? Let's ask the police, shall we?

Neighbourhood Policing Inspector Andy Crouch said he believed the decrease was down to police targeting problem areas with CCTV and more patrols, as well as moves to make car parks more secure.

I see.

"I think it's been down to good problem solving and good visibility," said Insp Crouch. "Car parks are safer now, we've covered them with CCTV.

That would certainly make sense.

Insp Crouch said police had been educating people about the dangers of leaving valuables in their cars, and used signs to make people think twice about leaving items on display.

So nothing to do with smoking ban, then. Anything else?

Mr Vaughan-Newton said the integrated offender team management project, where police keep tabs on known offenders when they are released and try and help them get jobs, had also helped.

This all sounds very plausible.

He said that CCTV coverage had also contributed to the reduction in car crime and that a camera used by Sainsbury's in Daybrook had had a knock-on effect, reducing car crime in the Premier Travel Inn opposite, which also came within its line of vision.

Interestingly, if you look at the web address of this news story, you will see that the original headline was the less sensational, but more accurate, 'Car crime has reduced by almost a quarter in Gedling Borough in the last year'. Looks like the editor felt it needed spicing up.

Wednesday, 3 March 2010

The amount Action on Smoking Health raised from voluntary donations in the entire financial year 2008/09. The intense lobbying of this charity is regularly reported in every newspaper in the UK and its activities were pivotal in bringing about a total smoking ban in England.

£6,027

The amount raised in voluntary donations in two days by a small group of blog-readers in order to free Nick Hogan, a man imprisoned for breaching England's total smoking ban (as reported in just one UK newspaper).

Old Holborn and Anna Racoon's fundraising goes on. You can donate here. They have also found an extraordinary passage in a document the government issued to provide 'guidance' for councils:

In addition to the evidence of smoking taking place, the Courts have also indicated that they are taking into consideration the following matters:

• the number of occasions on which the council is able to demonstrate that information and advice on the smokefree requirements have been provided to the person in control;

• the failure by the person in control to take action after the receipt of such information and advice;

and

• public statements made by or on behalf of the person in control:

• that they do not agree with or support the smokefree legislation;

• that they are actively campaigning against it; or

• that they do not intend to do anything more than simply inform people that they should not smoke.

As OH says, this means that what you think of the smoking ban influences how severely you will be treated. What else can this be called but a thoughtcrime ?

To the authorities, it makes no difference that no one ever smokes in Mr Isbister's shop.

"I can't remember a time when people smoked in shops, so it's a like using a sledge hammer to crush a nut, and I thought it was about time someone stood up to it."

Indeed so. Unfortunately we know what happens to people who stand up to the bully state.

The smoking ban is the only law which requires millions of signs to be prominently displayed on private property. Shops are not compelled to put signs up saying 'No assaults permitted' or 'No drug use permitted'. Mandatory 'No Smoking' signs should never have been part of deal. They are superfluous. Ignorance of the law is no excuse. Their sole purpose is to hammer home the anti-smoking message at every turn. And, of course, there will always be jobsworths who use these petty regulations as a bully's charter.

Nottingham City Council says that the shop is the only building out of around 5,000 they have visited in the city since the law came into effect that has refused to comply.

How much have these 5,000 inspections cost the taxpayer, all in the name of prosecuting one man in a garden gift shop? An anonymous council jobsworth was quoted as saying:

"We have provided Mr Ibister with signs and have asked on numerous occasions for them to be displayed which he has refused to do, resulting in us serving a fine which he refused to pay. This has led to the court appearance.

"The Health Act 2006 requires that all smoke free premises display the appropriate sign at the entrance to the premises – we are simply upholding this national law."

Yes, the Nuremburg defence. Only following orders. It would, presumably, be too much to ask the council to use its own discretion and common sense, particularly since no complaints have been made and it is manifestly a victimless crime?

[The smoking ban] includes buildings such as churches, listed buildings and art galleries, and the council says there has been no challenge about the aesthetic impact of signs on premises.

Well, really, what would be the point? When religious leaders described mandatory signage in churches as "daft", "overkill" and "unnecessary", the Department of Health ignored them:

In response to this the Department of Health spokesman said: "I accept, without reservation, that there is a long tradition not to smoke in churches but, as I am sure people will appreciate, to have provided an exemption would have created a dangerous precedent."

Churches setting a dangerous precedent? What planet do these people live on?

Let's be clear. Both Hogan and Isbister have broken the law. The point is that both 'crimes'—"allowing people to smoke" and not publicising a well-known offence—should never have been made crimes in the first place.

Old Holborn is raising money for Nick Hogan's release. If you would like to donate, click here (but ignore his comments about smoking on trains and in shops. It is indeed illegal both to smoke and to "allow" smoking in the UK).

1) A man who used his two-year-old daughter as a decoy so he and his pregnant girlfriend could steal from three Poppy Appeal tins and a Multiple Sclerosis charity box over a period of two weeks last year, hiding the cash in their daughter’s buggy.The 25-year-old also pleaded guilty to carrying a lock knife, stealing a guitar, and the attempted theft of another collection tin. He has a string of previous theft convictions dating back five years.

2) A pub landlord convicted for non-payment of a fine for allowing a “mass smoke-in” in his pub on the day of the smoking ban. He no longer owns the pub, and is bankrupt.

About Me

Writer and researcher at the Institute of Economic Affairs. Blogging in a personal capacity.
Author of Selfishness, Greed and Capitalism (2015), The Art of Suppression (2011), The Spirit Level Delusion (2010) and Velvet Glove, Iron Fist (2009).

"Of all tyrannies, a tyranny exercised for the good of its victims may be the most oppressive. It may be better to live under robber barons than under omnipotent moral busybodies. The robber baron's cruelty may sometimes sleep, his cupidity may at some point be satiated; but those who torment us for our own good will torment us without end, for they do so with the approval of their own conscience."